Prevalence of Carbapenem-Resistant Enterobacteriaceae in Seoul, Korea

Prevalence of Carbapenemase Production Among Klebsiella and Escherichia coli Isolated From Urinary Tract Infections

Background and aim Urinary tract infections represent a substantial portion of healthcare-associated infections due to E. coli and Klebsiella. Carbapenems are broad-spectrum antibiotics considered highly effective in treating infections caused by multidrug-resistant bacteria. Carbapenem-resistant Enterobacteriaceae (CRE), including carbapenem-producing E. coli and Klebsiella isolates, have become a major concern as they limit treatment options. The study aims to determine the prevalence of carbapenemase-producing E. coli and Klebsiella while also comparing the effectiveness of two detection methods, namely the modified carbapenem inactivation method (mCIM) and modified Hodge test (MHT). Materials and methods A cross-sectional study was conducted from July 2022 to June 2023 in a tertiary care hospital, in Karad, Satara, India. Three hundred urinary isolates of E. coli (150) and Klebsiella (150) were studied. These isolates were tested for antimicrobial susceptibility testing. Two phenotypic methods, the modified carbapenem inactivation method (mCIM) and the modified Hodge test (MHT), were used to study carbapenemase production. Results Out of three hundred isolates, carbapenemase production was detected in 72 isolates (24%) by the modified Hodge test (MHT) and in 111 isolates (37%) by the modified carbapenem inactivation method (mCIM). Among the MHT-positive isolates, 46 (63.8%) were identified as Klebsiella and 26 (36.1%) as E. coli. In contrast, of the mCIM-positive isolates, 68 (61.2%) were Klebsiella, and 43 (38.7%) were E. coli. A total of 41 Klebsiella (27.33%) and 25 E. coli (16.66%) isolates tested positive by both methods, highlighting variability in detection rates between the two methods. Conclusion This study observed MHT and mCIM to be accurate for the detection of carbapenemase among carbapenem-resistant isolates. However, the mCIM demonstrated greater sensitivity compared to the MHT.

Epidemiology of Carbapenem-Resistant Enterobacteriaceae Bacteremia in Gyeonggi Province, Republic of Korea, between 2018 and 2021

The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing since 2008, with Gyeonggi Province in South Korea being particularly vulnerable due to its large number of healthcare facilities. This study examines the trends of CRE occurrence in Gyeonggi Province over the past four years and the epidemiological characteristics of the infected patients. Patients with positive CRE blood cultures admitted to healthcare facilities in Gyeonggi Province from January 2018 to December 2021 were evaluated in this study. Risk factors for CRE-related death were analyzed using data from patients who died within 30 days of the last blood sampling. Older adults aged 70 years and above constituted the majority of patients with CRE bacteremia. Antibiotic use did not significantly affect mortality risk. Non-survivors were more common in tertiary hospitals and intensive care units and included patients with hypertension, malignant tumors, and multiple underlying diseases. Klebsiella pneumoniae was the most common CRE strain, with Klebsiella pneumoniae carbapenemase being the predominant carbapenemase. Our study suggests the endemicity of CRE in Gyeonggi Province and highlights the increasing isolation of CRE strains in South Korean long-term care hospitals within the province. Further, infection control measures and government support specific to each healthcare facility type are crucial.

Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies

OBJECTIVES

Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea.

METHODS

The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022).

RESULTS

We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF's isolation wards.

CONCLUSIONS

This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Identification and infection control of carbapenem-resistant Enterobacterales in intensive care units

Infections with multidrug-resistant organisms among patients in intensive care units (ICUs) are associated with high mortality. Among multidrug-resistant organisms, carbapenem-resistant Enterobacterales (CRE) harbor important pathogens for healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infections. Risk factors for CRE colonization include underlying comorbid conditions, prior antibiotics exposure, prior use of healthcare facilities, device use, and longer ICU stay. The mortality rate due to invasive CRE infection is 22%–49%, and CRE colonization is associated with an approximately 10-fold increased risk of CRE infection. Infection control measures include hand hygiene, contact precautions, minimizing the use of devices, and environmental control. Additionally, implementing active surveillance of CRE carriage should be considered in ICU settings.